Laparoscopic Technique for Peritoneal Pull-Through Vaginoplasty in the Transfeminine Patients

Study Objective

To present a laparoscopic approach to peritoneal pull-through vaginoplasty and review its indications.

Design

Surgical video and one-week postoperative follow up of peritoneal pull-through vaginoplasty performed with laparoscopic assistance.

Setting

Patients had their surgery at the Belgrade Center for Reconstructive Surgery in Belgrade, Serbia. The procedure required two surgeons: a reconstructive urologist and a laparoscopic surgeon. Patients were positioned in dorsal lithotomy position for the duration of the procedure. The surgery requires 5 steps: penile deconstruction, laparoscopic sampling of peritoneal flaps, dissection of the neovaginal space, peritoneal pull-through and suturing of the vaginal anastomosis and laparoscopic closure of the neovagina. For the laparoscopic part of the surgery, a 10 mm supra umbilical port was used for laparoscope insertion and two 5 mm right lateral ports were used for the surgeon. Total operating time was 5-7 hours. Patients were admitted to hospital for 4-7 days following surgery. All patients were seen 7 days after surgery for vaginal packing removal and vaginal dilation counselling.

Patients or Participants

Three patients appear in the presented surgical photos and videos. All patients provided written consent for their participation.

Interventions

Peritoneal pull-through vaginoplasty for gender affirming surgery.

Measurements and Main Results

All patients had successful surgery with no complications. Vaginal depth at 7 days postoperative varied between 14-16 cm in all three patients.

Conclusion

Peritoneal pull-through vaginoplasty is a viable option for gender-affirming vaginoplasty. Increased involvement of skilled laparoscopic surgeons in gender affirming care is required to make it readily available.